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The latest updates and information Mississippi Medicaid providers need to know is posted in Late Breaking News

Sign up to receive email alerts every time DOM posts a Late Breaking News update! Just email a contact name, place of business and a contact number (optional) to LateBreakingNews@medicaid.ms.gov.

 


6/11/2024

Telligen Change Request Form – How to Request Changes or Updates to an Existing Prior Authorization

Navigating the complexities of healthcare administration often involves managing prior authorizations (PAs) for various medical services and treatments. When an update or change to an existing PA is necessary due to evolving patient needs or administrative adjustments, this article outlines the steps and best practices for requesting changes or updates to an existing PA using Telligen’s Change Request Form.

Understanding Prior Authorizations (PAs)

Prior Authorizations are a prerequisite from Medicaid to approve a prescribed treatment, procedure, or medication before it is provided. This process ensures that the service is medically necessary.

When to Use a Change Request Form

The Change Request Form is essential for situations where an existing PA needs modification, which can include, but are not limited to:

  • Adding or changing service codes
  • Updating the quantity of services approved
  • Modifying patient or provider information
  • Adding appropriate billing modifiers

*Please note that the Change Request Form should not be used for reconsiderations of denied PAs. A separate process is utilized that typically involves a 1st level appeal and/or reconsideration request.

Steps to Request Changes or Updates

  1. Access the Change Request Form on the Telligen website : MS-Change-Request-Fill-In-Form.pdf (telligen.com).
  1. Complete the form accurately by providing all required information such as the original PA number, patient details, provider details, and specifics about the changes requested. The specific nature of the change needs to be clearly documented, whether it’s adding a service, modifying quantities, or updating information.
  2. Ensure supporting documentation is attached, which may include any relevant medical records, notes from providers, or other documentation that supports the requested change.
  3. Submit the form in one of the following methods:
    1. Email the completed form and supporting documentation to MSMedicaidUM@Telligen.com.
    2. Fax the form to (800) 524-5710
  4. Follow Up
  5. After submission, follow up with the recipient to confirm receipt and to inquire about the status of your request.
  6. Keep records of all correspondence and submissions for your records.

Best Practices

  • Timely Submission: Submit change requests as soon as the need for a modification is identified to avoid delays in patient care.
  • Clear Communication: Ensure all information is clearly and accurately provided to prevent processing delays.
  • Maintain Documentation: Keep copies of all submitted forms and related correspondence.
  • Note: Telligen cannot revise a PA for which a claim has already been paid. The paid claim must be voided before the PA can be changed. The Change Request form must be received within 90 days of the date of the approval on the PA decision letter.

Managing PAs effectively is essential for seamless healthcare delivery. Using the Change Request Form to update or modify an existing PA ensures that patient care is not disrupted, and administrative processes remain smooth.  By following the outlined steps and best practices, providers can efficiently handle necessary changes to PAs.

 


6/11/2024

Change Healthcare Is Ready to Begin Submitting XYZ Transactions Again

In an effort to assist DOM providers impacted by the Change Healthcare security breach, after thorough security testing by the Change Healthcare team, DOM and Gainwell Technologies have reactivated Change Healthcare’s access to once again submit transactions for processing. We appreciate your understanding as we have worked through this with Chance Healthcare to ensure the protection of data housed in the Gainwell systems.

Should further assistance be needed please contact your Change Healthcare account representative for specific information regarding your account.

 


6/3/2024

New Email Address for Provider Document Submission

A new email address has been created for submission of supporting documents related to provider enrollment applications, revalidations, and recredentialing. If a Gainwell Provider Enrollment Analyst requests missing or corrected documents via email or by a Return-To-Provider (RTP) letter, please send them to the new email address: ms_pe_docs@gainwelltechnologies.com. This will ensure the provider enrollment team receives your documents should you encounter issues uploading them through the web portal.

Remember to include the application tracking number (ATN) in the subject line of your email.

Note: This email address is for supporting documents only. For provider and claim inquiries, continue to use the email address of ms_provider.inquiry@mygainwell.onmicrosoft.com.

 

 


5/31/2024

Expired Provider License Updates Required

It is imperative for providers to promptly provide their updated licensure information to Medicaid, as failure to do so will result in the closure of their Medicaid provider number and interruption of claim payments.

Who is impacted?
Under the guidelines of 42 CFR § 455.412, the Mississippi Division of Medicaid (DOM) is required to have current licenses in the provider file for both fee-for-service/MississippiCAN providers and CHIP providers.

When should licenses be updated?
As a part of this process, providers whose licenses have expired or are expiring will be notified via mailed notifications from Gainwell Technologies. We also encourage providers to consult DOM’s official website, where the Provider Six-Month License Due List is available at https://medicaid.ms.gov/. This list will be refreshed monthly to ensure the latest information is accessible.

How can a provider submit the updated license?
To facilitate the submission of licensure information, Gainwell Technologies’ Provider Enrollment Department offers multiple secure channels, including the MESA Provider Portal, fax, or mail. Here are the details for each method:

Online: MESA Provider Portal: https://medicaid.ms.gov/mesa-portal-for-providers (via the Secure Correspondence link)
Fax: Provider Services Fax Number: (866) 644-6148
Attention: Provider Enrollment
Mail: Provider Services Mailing Address:
Provider Enrollment/MississippiCAN/MSCHIP
PO Box 23078
Jackson, MS 39225

If a provider fails to send in the updated license timely can a provider be reinstated?
Complying with the provisions outlined in the Mississippi Administrative Code Part 200, Chapter 4, Rule 4.5 (B) (C), DOM will reinstate closed provider numbers due to license expiration, retroactive to the date of license renewal, provided the closure duration is under one (1) year and the provider is not past due for revalidation or recredentialing. For this to happen, the provider must furnish a current license copy and rectify any changed or inaccurate information. If a Medicaid provider number has been closed due to license expiration for a period exceeding one (1) year, re-enrollment as a Medicaid provider will be necessary.

For any assistance required between 8 a.m. and 5 p.m. CST, providers can contact the Provider and Beneficiary Services Call Center at (800) 884-3222.

 

 


5/29/2024

Telligen Change Request Form – How to Request Changes or Updates to an Existing Prior Authorization

Navigating the complexities of healthcare administration often involves managing prior authorizations (PAs) for various medical services and treatments. When an update or change to an existing PA is necessary due to evolving patient needs or administrative adjustments, this article outlines the steps and best practices for requesting changes or updates to an existing PA using Telligen’s Change Request Form.

Understanding Prior Authorizations (PAs)

Prior Authorizations are a prerequisite from Medicaid to approve a prescribed treatment, procedure, or medication before it is provided. This process ensures that the service is medically necessary.

When to Use a Change Request Form

The Change Request Form is essential for situations where an existing PA needs modification, which can include, but are not limited to:

• Adding or changing service codes
• Updating the quantity of services approved
• Modifying patient or provider information
• Adding appropriate billing modifiers

*Please note that the Change Request Form should not be used for reconsiderations of denied PAs. A separate process is utilized that typically involves a 1st level appeal and/or reconsideration request.

Steps to Request Changes or Updates

1. Access the Change Request Form on the Telligen website: https://msmedicaid.telligen.com/wp-content/uploads/2024/03/MS-Change-Request-Fill-In-Form.pdf.
2. Complete the form accurately by providing all required information such as the original PA number, patient details, provider details, and specifics about the changes requested. The specific nature of the change needs to be clearly documented, whether it’s adding a service, modifying quantities, or updating information.
3. Ensure supporting documentation is attached, which may include any relevant medical records, notes from providers, or other documentation that supports the requested change.
4. Submit the form in one of the following methods:
a) Email the completed form and supporting documentation to MSMedicaidUM@Telligen.com.
b) Fax the form to (800) 524-5710
5. Follow Up
a) After submission, follow up with the recipient to confirm receipt and to inquire about the status of your request.
b) Keep records of all correspondence and submissions for your records.

Best Practices

• Timely Submission: Submit change requests as soon as the need for a modification is identified to avoid delays in patient care.
• Clear Communication: Ensure all information is clearly and accurately provided to prevent processing delays.
• Maintain Documentation: Keep copies of all submitted forms and related correspondence.
• Note: Telligen cannot revise a PA for which a claim has already been paid. The paid claim must be voided before the PA can be changed. The Change Request form must be received within 90 days of the date of the approval on the PA decision letter.

Managing PAs effectively is essential for seamless healthcare delivery. Using the Change Request Form to update or modify an existing PA ensures that patient care is not disrupted, and administrative processes remain smooth. By following the outlined steps and best practices, providers can efficiently handle necessary changes to PAs.